healthy longevity initiative for old age
‘healthy longevity initiative
The divide between the real world and the strategy to be adopted in the healthy longevity initiative is too wide to be ignored
वास्तविक दुनिया और स्वस्थ दीर्घायु पहल में अपनाई जाने वाली रणनीति के बीच का अंतर इतना बड़ा है कि उसे नजरअंदाज नहीं किया जा सकता
REPORT OF WORLD BANK
About report
‘Unlocking the Power of Healthy Longevity: Demographic Change, Non-communicable Diseases, and Human Capital’
that was published in Washington DC in September 2024.
rapidly aging population
This change is most in Low-and Middle-Income Countries (LMIC)
As non-communicable diseases (NCD) are the leading cause of deaths.
Most NCD deaths occur in LMICs, and the proportion of all deaths caused by NCDs is likely to surge among them.
Projections suggest a global surge in deaths from
- 61 million in 2023
- to 92 million in 2050,
- as well as related increases in needs for NCD-related hospitalisation and long-term care.
If LMICs can achieve ambitious yet feasible rates of progress
the world could avert / stop 25 million deaths annually by 2050,
effectively halving avoidable deaths and meeting the related Sustainable Development Goals (SDG).
healthy longevity initiative HLI
Driven by this concern, the World Bank report proposes a healthy longevity initiative (HLI) which takes a life course approach.
Briefly, healthy longevity entails
sharply
- reducing avoidable death
- and serious disability throughout the life cycle,
- as well as increased levels of physical, mental, and social functioning through middle and older ages,
- short period of time before inevitable death (World Bank, 2024).
But Whether this is feasible in LMICs, especially India, is debatable ?
this program imagines a world in which
- health care is accessible,
- doctors and nurses, and para medical staff are competent,
- honest, and committed to proper patient care,
- hospitals are well-equipped,
- the monitoring of patients is systematic and digitised,
- awareness of benefits of early detection and treatment of NCDs.
World Bank report discusses
health expenses and impoverishment, and inadequate state funding of health care, the chasm between the real world and that which is subsumed in the HLI is much too deep to be overlooked.
Indeed, a world without
- quacks,
- corrupt doctors,
- exploitative hospitals,
- pharmaceutical companies pushing unsafe medicines,
- and patients with chronic conditions travelling hundreds of miles is rarefied.
India’s elderly population, disease concerns
भारत की बूढ़ी होती जनसंख्या
The older population of India is currently the world’s second largest — 140 million people
who are aged 60 years and above (compared to 250 million people in China).
Moreover, the average annual growth rate of the older population is almost three times higher than the overall population growth rate
India fastly going (60 years-plus) into NCDs (for example, cardiovascular diseases, cancer, chronic respiratory diseases and diabetes)
This could have disastrous consequences in terms of an impoverishment of families, excess mortality, lowering of investment and a consequent deceleration of economic growth.
क्या करने की जरूरत ?
Worse, the government has to deal simultaneously with the rising fiscal burden of NCDs and infectious diseases.
As a report by The Lancet (2018) emphasises, failure to devise a strategy and make timely investment now will jeopardise achievement of SDG 3 (‘good health and well-being’) and target 4 of a one-third reduction in premature mortality from NCDs by 2030.
NCD morbidity and mortality
. In 1990, NCDs accounted for 40% of all Indian mortality and are now projected to account for three quarters of all deaths by 2030.
Currently, cardiovascular diseases, cancer, respiratory illness and diabetes are the leading causes of deaths in India, accounting for almost 50% of all deaths (The Lancet, 2018).
कुछ और भी हैं NCDs ?
These include tobacco use, alcohol abuse, and obesity due to sedentary lifestyles and diets that are getting to be increasingly high in simple carbohydrates and saturated fats.
Many populations, particularly in remote rural areas, lack easy or frequent access to primary health-care practitioners who can provide regular screenings for common NCDs.
Impact of social security schemes
The focus here is on diabetes and heart diseases
social security measures/schemes
The writers of this article examine whether participation in social security measures/schemes reduces the prevalence of two specific NCDs
Or utilisation of medical services/hospital visits also reduces the prevalence of NCDs.
India Human Development Survey 2015
it is the only all-India panel survey to date, the analysis is based on this survey, supplemented by Longitudinal Aging Study in India (LASI 2017-18) conducted jointly by the International Institute for Population Sciences (IIPS) and Harvard School of Public Health.
Pension for old age
Even though pension amounts are meagre, they supplement scanty resources of the elderly poor in covering health-care expenses and thus reduce the NCDs. For treatment of such diseases, hospital visits are unavoidable.
Financial burdens for old age
However, travel costs, fees and costs of medicines impose a huge financial burden, resulting in large out-of-pocket expenditure and indebtedness and immiseration.
While health insurance
is useful in restricting the financial burden, this potential is far from fully realised due to limited awareness of eligibility requirements, elaborate documentation, delays in payments, and rejection of claims.
खान पान से रिस्क
Diets high in refined grain intake
cause an increased risk of premature coronary artery disease while rice intake beyond a threshold causes diabetes.
Higher intake of red meats such as beef, pork and mutton also contribute to higher risks of diabetes and heart diseases.
Besides, a rise in the price ratios of fat-dense foods (sugar and oil) aggravates the risk of both diabetes and heart disease.
diabetes and heart diseases
There are various reasons why diabetes rises with age such as a sedentary lifestyle, high-calorie diet, visceral adiposity,
and high genetic predisposition mellitus (type 2) diabetes among Indians at a much younger age and at a lower body mass index (BMI) than the western population.
problem with Ausman bharat scheme ??
Ayushman Bharat Scheme that aims to provide health insurance coverage to the bottom 40% of households.
But its potential has been far from fully realised due to
- inadequate funding
- and stringent eligibility requirements,
(for example, large numbers of
- ineligible beneficiaries,
- long delays in empanelment of hospitals,
- surgeries performed after discharge,
- and utilisation certificates without signature of competent authorities).
- However, insurance alone might not be sufficient to achieve access to quality care, which depends on health-care infrastructure, provider availability, and local culture.
Hospital expenses
regulate the rates of private hospital procedures
As private hospitals are notorious / famous for inflated prices of health care, the Supreme Court of India directed the central government in February 2024 to find ways to regulate the rates of hospital procedures.
As the Court observed, pricing decisions must be informed by a benchmark for price determination.
While price caps do influence actors’ behaviour by making them follow the regulations, these effects tend to be temporary when enforcement mechanisms are weak.
Behavioural changes
are no less important, and perhaps also no less challenging. Lack of physical activity and unbalanced high-calorie diet promote weight gains.
Obesity
is a risk factor for cardiovascular diseases and diabetes and can aggravate risks of cardiovascular disease such as emphysema and bronchitis.
Limiting tobacco
consumption is expected to have benefits at the individual level but wider reduction in multi-morbidity prevalence requires taxation on unhealthy products.
In conclusion, if and when these policy reforms will be carried out is anybody’s guess.
source the hindu
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